Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 294216 | NY |
NPI | 1003171778 |
---|---|
Provider Name | Dr. Rahul Ravilla |
First Address | Halfmoon, NY 12065-3239 |
Second Address | Albany, NY 12208-3412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 28/06/2019 |